Some ob-gyns cite religious conflicts over care

NEW YORK (Reuters Health) - More than one-third of obstetrician-gynecologists at religiously-affiliated hospitals say they've had a conflict with their institution about patient care policies based on religious tenets -- including over half of ob-gyns at Catholic hospitals, according to a new survey.

The researchers didn't ask doctors exactly what those conflicts were about, but the lead author said in her experience disagreements typically come up over sterilization procedures for men, the use of contraception and the treatment of miscarriages.

"My advice to women is really to ask questions before you pick what hospital you're going to go to for your reproductive health care and your pregnancy-related care," said Dr. Debra Stulberg, from the University of Chicago.

Women and their doctors might find themselves in a bind, for example, in the case of a miscarriage. At Catholic institutions, treating a woman for an imminent miscarriage can be considered abortion if the fetus still has heart tones, researchers said.

"People usually assume that if they're going to a Catholic hospital for prenatal care and delivery, (then) abortion restrictions won't mean anything to them because of course they're not going there for an abortion," said Lori Freedman, a medical sociologist from the Advancing New Standards in Reproductive Health research group, at the University of California, San Francisco, who was not involved in the study.

But, Freedman added, "Care during the time of pregnancy could be complicated in these institutions."

Since the new study's completion, she has started collaborating with Stulberg on follow-up interviews with some of the doctors surveyed.

For the current report, Stulberg and her colleagues surveyed more than 1,100 ob-gyns across the United States about their experiences at their respective hospitals and practices.

One in five of the doctors practiced at a religiously-affiliated institution. And of those, 37 percent reported some history of conflict regarding patient-care policies based in religion.

At Catholic hospitals in particular, 52 percent of ob-gyns had experienced conflict over those policies, Stulberg's team reported in the American Journal of Obstetrics and Gynecology.

"There's really a striking difference between people who practice in Catholic hospitals and people who practice in hospitals of all other religious denominations," Stulberg told Reuters Health. "Some of these conflicts seem to be unique to Catholic hospitals."

That's likely because Catholic health care institutions have the most specific restrictions on patient care and cover the widest breadth of reproductive services with their policies, noted Freedman -- such as not giving out birth control.

Few ob-gyns at religious or non-religious hospitals said they were limited in treating ectopic pregnancy -- when an embryo starts developing outside the uterus and can't survive.

How ectopic pregnancies should be treated has been a matter of debate among Catholic ethicists, according to the report.

"I was happy to see that it seems like most hospitals do not interfere with physician judgment in that situation," Stulberg said.

The study comes amid ongoing controversy over an Obama administration policy requiring insurance plans at Catholic hospitals and other religiously-affiliated organizations to cover contraception for their employees.

According to the Catholic Health Association of the United States (CHAUSA), about 13 percent of all U.S. Hospitals are Catholic, and they account for close to 16 percent of hospital admissions nationwide.

Researchers said it's important for religious bodies and institutions to clarify policies so there isn't confusion among their doctors about what is and isn't allowed -- and for women themselves to know, going in, if there are any ways in which their care could be limited based on those policies.

A representative for CHAUSA wrote in an email to Reuters Health, "Physician education programs are not new at most Catholic hospitals, having been underway for many years. Furthermore, the Catholic Health Association of the United States is developing additional resources to its well-received educational resources on the Ethical and Religious Directives for Catholic Health Care Services, including segments especially geared to physicians."

The new research was funded by the National Institutes of Health, as well as the Greenwall Foundation, which supports bioethics research, and the John Templeton Foundation.

"Recently the Catholic bishops have been talking about this as if it's a primarily religious freedom issue," Stulberg said.

"Sometimes what gets lost is it's also an access-to-care issue for women and also that women have the right to have the care they receive match their own values... And if they're getting their treatment in a hospital that has strict policies, the hospital's values may trump theirs."